The new Health Care Act

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The government is planning to enact a completely new Health Care Act which would regulate the organisation of municipal health care services in the future. A working group set by the Ministry of Social Affairs and Health has made a proposal for the new act. It would reform the system by several means: by increasing co-operation between primary and secondary care, by increasing patient choice and by somewhat centralizing the steering of health services. The bill is going to be passed in 2009.

Purpose of health policy or idea

The government is planning to merge the Primary Health Care Act (enacted in 1972) and the Act on Specialized Medical Care (enacted in 1989) into a comprehensive Health Care Act. These acts regulate the provision of public sector (municipal) health services. Currently municipal primary care is organized by about 260 health centres owned by a municipality or a group of municipalities, specialized care is organized by 20 hospital districts (formed by municipalities) and the organization of tertiary care is co-ordinated by five tertiary care regions (formed by hospital districts).

A working group set up by the Ministry of Social Affairs and Health has made a proposal for the new act. Central reforms in the proposed act are the following:

• to increase patient choice by enabling patients to freely use services of any health centre inside the same tertiary care region and by enabling the patient - together with the referring physician - to choose any hospital within the same tertiary care region. Currently patients must use the services of the health centre run by his/her home municipality and there is no choice on hospital either.
• to lower the barriers between primary and specialized health care and somewhat centralize the organization of primary care. There are two models presented to achieve this, which according to the model could co-exist. In the first model the organizational responsibility for primary and specialized care is merged to the same regional organization called health district. In the second model organizational responsibility would remain with the municipality (for primary health care) and with the hospital district (for specialized care) but co-operation between these two would be increased by for example hospital districts providing some basic specialist level services in municipal level;
• to improve the mobility of patient records within hospital districts by allowing the transfer of the records between hospitals and primary health care units without consent of the patient (currently explicit consent is needed);
• to centralize the organizational responsibility of ambulance and emergency on-scene services to hospital districts (currently municipalities have the organizational responsibility for this);
• to strengthen the role of tertiary care regions by giving them more responsibilities in coordinating activities in the region (for example coordination of continuous medical education, coordination of uptake of new medical methods, and consolidation of service production between hospital districts).

Main points

Main objectives

The central aims of the reform are to strengthen primary health care, to improve access to services and efficiency of service production, to increase co-operation between primary and specialized care, to improve customer orientation and to decrease differences in health status between population groups and geographical areas.

Type of incentives

The barrier between primary and specialized care is regarded as one of the main problems of Finnish health care system, which partly stems from having separate acts regulating them. While these acts are merged several other aspects of the health care system needing improvement are to be addressed as well (such as consumer orientation).

Groups affected

Municipalities, Hospital districts, Patients

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Improving the coordination of primary and specialized care is not a brand new idea. There have been for example several regional reforms to pilot this. Some other issues in the proposal are more innovative, however. Perhaps the most fundamental change is the increase of patient choice. So far public discussion on the reform has been modest and there have not emerged any strong controversies about it.

Political and economic background

There has been discussion on merging the acts for a long time but the major step forward was taken when the current government came into office in April 2007. The program of that government (a plan of action defining the main tasks facing the incoming administration) stated among other things that the Primary Health Care Act and the Act on Specialized Medical Care will be combined into a comprehensive Health Care Act to lower the barriers between primary and specialized care and to improve co-operation (see HPM 10/2007).

Change of government

April 2007

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The idea to merge these two acts is not novel, but because of a lack of political will, process for the legislation reform had not been started earlier. Having separate acts and organizational structures for primary and specialized care has hindered co-operation between these levels which can hamper the optimal organization of care from both the clinical and economical perspective. For example, sharing patient records and other information between primary and specialized care can be difficult. The separate organizations can also lead to a situation where primary health care has a too weak position in resource allocation. When facing a difficult financial situation, municipalities have better possibilities to limit the costs of their own health center than those of the hospital district.

These acts would need technical reform in any case. Especially the Primary Health Care Act is old (from 1972) and has been amended many times which has made the law rather difficult to interpret.

There have been a few local reforms which have piloted the merging of organizational responsibility of primary health care and specialized care (see HPM 9/2007 and HPM 2/2003), which have been considered to be rather successful.

Initiators of idea/main actors

• Regierung

• Leistungserbringer

• Patienten, Verbraucher

• Andere

Approach of idea

The approach of the idea is described as:
renewed:

Innovation or pilot project

Local level - see HPM 9/2007 and HPM 2/2003

Stakeholder positions

The working group which drafted the act included representatives from the Ministry of Social Affairs and Health, from the Ministry of Finance, from the Association of Finnish Local and Regional Authorities, from two hospital districts, from one municipality and from three municipal federations providing primary health services.

The themes of the reform are not very controversial, partly because the proposed act is rather general giving just broad outlines for organization of services (like the current acts on primary care and specialized care). The proposal introduces two alternative schemes for organizing primary and specialist care, instead of a single scheme for the whole country. One of the main concerns voiced against the merging of acts has previously been that it can lead to a situation where primary health care would have an even weaker position than it currently has.

However, there will probably be much discussion between the different stakeholders on the details. The ministry has asked all stakeholders to provide written statements on the proposal by the end of October 2008. Public discussion on the proposal of the working group has not really started yet.

Increasing patient choice, which is one of the main novel issues proposed, has not been so much voiced by patients or the public but for example the Finnish Medical Association and private providers have been active in promoting this issue for some time.

Actors and positions

Regierung
Government	sehr unterstützend		stark dagegen
Ministry of Social Affairs and Health	sehr unterstützend		stark dagegen
Leistungserbringer
Municipalities	sehr unterstützend		stark dagegen
Hospital districts	sehr unterstützend		stark dagegen
Patienten, Verbraucher
Public	sehr unterstützend		stark dagegen
Patient organizations	sehr unterstützend		stark dagegen
Andere
Physicians	sehr unterstützend		stark dagegen
Nurses	sehr unterstützend		stark dagegen

Influences in policy making and legislation

After the current government took office, the Ministry of Social Affairs and Health set up a working group in June 2007 to draft a proposal for the new act. The proposal was finalized and publicized by the working group in June 2008. After a thorough process to hear the opinions from relevant stakeholders, the government is planning to pass the bill to parliament in 2009.

Legislative outcome

pending

Actors and influence

Regierung
Government	sehr groß		kein
Ministry of Social Affairs and Health	sehr groß		kein
Leistungserbringer
Municipalities	sehr groß		kein
Hospital districts	sehr groß		kein
Patienten, Verbraucher
Public	sehr groß		kein
Patient organizations	sehr groß		kein
Andere
Physicians	sehr groß		kein
Nurses	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The main actors to be involved in the adoption process are municipalities and hospital districts. The adoption process will be moderated by the Ministry of Social Affairs and Health.

Monitoring and evaluation

Not decided yet.

Review mechanisms

keine Angaben

Expected outcome

It is possible that this act will be one of the major mile stones in the development of the Finnish health care system since the 70's when the Primary Health Care Act was enacted. However, the proposal made by the working group does not necessarily implicate that there would be in practice many fundamental changes in the system. Perhaps the most promising feature of the proposed act is that it gives a rather good platform for future developments of the municipal health care system as a whole.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

At this stage it is difficult to estimate what is going to be the real impact of the reform on equity, quality and cost-efficiency of health services in Finland.

References

Author/s and/or contributors to this survey

Vuorenkoski, Lauri

Empfohlene Zitierweise für diesen Online-Artikel:

Vuorenkoski, Lauri. "The new Health Care Act". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/fi/a12/3